B12 deficiency related to hemolysis?

[bflare]

I have had elevated Bilirubin for some time which was put down to gilbert syndrome. However, my haematologist who i see for hemochromatosis requested a DAT test for hemolysis screen. I have now had an email sent for what looks to be an urgent appointment which i am guessing is to discuss the results.Some of my results area s follows:

Serum conjugated bilirubin - 9 umol/L (<4.0)

Serum Total bilirubin 32 umol/L (2.0 - 21.0)

Serum conjugated / total bilirubin ration 28%

Haemoglobin - 173 g/L (13.0 -170)

MCV - 99 fl (83-101)

MCH - 33.6 (27 - 32)

Active B12 - 58 pmol/L (37.5 - 150)

MMA - 54 ug/L (< 32)

I am panicking a little now as to what they have found. I'm sure I've read somewhere that hemolysis can be caused by B12 deficiency?

I do believe i am B12 deficient which i am seeking treatment for via private sector as my GP is useless.

Any advice please?

[Nackapan]

I don't understand the blood results. If its Gilbert's syndrome that's not a worry my daughter also has that.

Don't be too alarmed by an 'urgent ' or fast track appointment.

It's a way to get you seen quicker which is good .

I realise easier said than done but you will get the facts soon and hopefully be guided with a way forward.

[bflare in reply to Nackapan]

It's always been suspected as Gilbert syndrome as there was no apparent organ damage on the various scans I've had. However, at my last hematology appointment my haematologist wanted to do a coombs test which is also called a DAT test to make sure it was Gilbert's and not some kind of hemolysis. I'm assuming that's what I've had an urgent appointment scheduled for. The blood results are just to give an idea of my various levels.

[Nackapan in reply to bflare]

DAT test ad I understand it looks for any antibody interaction .Hope your appointment soon so you get some answers .

[FlipperTD]

Here we go... Scientist's answer, not a medic's.

B12 deficiency is typically associated with megaloblastic erythropoiesis. Bigger red cells are made. These red cells, whilst they transport oxygen and carbon dioxide effectively, and do everything a red cell should, like metabolise glucose, they don't last as long as someones red cells when they have normoblastic erythropoiesis. So, this megaloblastic erythropoiesis can be classed as 'ineffective erythropoiesis', and as the cells are being destroyed early, then that's a haemolytic process. So, whilst this might sound like a 'haemolytic anaemia' then it's fair to say that your Hb of 17.3 g per decilitre is very, very normal. So you're not anaemic.

Folks with B12 deficiency are often found to have a mild jaundice.

If you have Gilbert's syndrome then that's another cause of a raised bilirubin, and that's something you're stuck with, but it's very much a 'so what?' It's an inherited condition.

A Direct Antiglobulin Test looks for antibody-coated red cells. Yes, it's a possibility, but with a normal Hb it's 'unlikely'! Have you had a reticulocyte count? That would generally tell if you've got haemolysis because it'd be raised.

There's no reason to suggest that it couldn't be both, so a pre-existing Gilbert Syndrome diagnosis could be further compounded by other processes, but [IMHO] it's unlikely.

Your Haematologist is just being very cautious and this is possibly due to your worrying!

In the words of Lance Corporal Joe Jones, of Dad's Army, 'Don't panic!'

If your FBC values are stable, and I know you spreadsheet them, well, try not to worry.